Names and pronunciation
C (koe-less-tir′a-meen) Prevalite
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Drug reference
C (koe-less-tir′a-meen) Prevalite
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Func. class.: Antilipemic
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Chem. class.: Bile acid sequestrant
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Do not confuse: Questran/Quarzan
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ACTION: Adsorbs, combines with bile acids to form insoluble complex that is excreted through feces; loss of bile acids lowers LDL, cholesterol levels
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USES: Primary hypercholesterolemia (esp. type IIa/IIb hyperlipoproteinemia), pruritus associated with biliary obstruction
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CONTRAINDICATIONS: Hyper- sensitivity; complete biliary obstruction; hyperlipidemia III, IV, V Precautions: Pregnancy, breastfeeding, children, PKU, renal disease, coagulopathy
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SIDE EFFECTS CNS: Headache, dizziness, drowsiness, vertigo, tinnitus, anxiety GI: Constipation, abdominal pain, nau- sea, fecal impaction, hemorrhoids, flatu- lence, vomiting, steatorrhea, peptic ulcer HEMA: Bleeding, increased PT INTEG: Rash, irritation of perianal area, tongue, skin META: Decreased vitamin A, D, K, red cell folate content; hyperchloremic acidosis MS: Muscle, joint pain
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INTERACTIONS Decrease: absorption of warfarin, thia- zides, cardiac glycosides, propranolol, corticosteroids, iron, thyroid hormones, acetaminophen, amiodarone, penicillin G, tetracyclines, clofibrate, gemfibrozil, oral vancomycin, glipiZIDE; vitamin A, D, E, K Drug/Lab Test Increase: AST, ALT, alkaline phosphatase Decrease: sodium, potassium
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DOSAGE AND ROUTES • Adult: PO 4 g/day or bid, max 24 g/day • Child: PO 240 mg/kg/day in 3 divided doses with food or drink, max 8 g/day titrated up over several weeks to decrease GI effects
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Available forms: Powder for suspension 4 g cholestyramine/packet or scoop; tablet 1 g
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Administer: • Product daily or bid; give all other medications 1 hr prior to or 4-6 hr after cholestyramine to avoid poor ab- sorption • Product mixed with applesauce or stirred into beverage (2-6 oz), let stand for 2 min; do not take dry, avoid inhaling powder, avoid GI tube administration, take with food • Supplemental doses of vitamin A, D, K if levels are low • Doses are expressed in anhydrous cholestyramine resin; amount of resin varies with each product
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Assess: • Cardiac glycoside level if both prod- ucts administered, may need to adjust dose of cardiac glycoside if this product is increased or decreased • For signs of vitamin A, D, K deficiency • Hypercholesterolemia: fasting LDL, HDL, total cholesterol, triglyceride levels, electrolytes if receiving extended therapy; diet history • Pruritus: for signs of itching • Bowel pattern daily; increase bulk, water in diet for constipation; diarrhea may also occur • Pregnancy/breastfeeding: no well- controlled studies; may decrease vitamin absorption (fat-soluble); use only if ben- efits outweigh fetal risks; cautious use in breastfeeding, vitamins may be decreased
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Evaluate: • Therapeutic response: decreased LDL, cholesterol level (hyperlipidemia); diar- rhea, pruritus (excess bile acids)
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • About the symptoms of hypopro- thrombinemia: bleeding mucous mem- branes, dark tarry stools, hematuria, pe- techiae; report immediately • To take with food, never use dry • That PKU patients should avoid Questran Light (contains aspartame and phenylalanine) • About the importance of compliance • That risk factors should be decreased: high-fat diet, smoking, alcohol consump- tion, absence of exercise • That GI side effects will resolve with continued use
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PHARMACOKINETICS PO: Excreted in feces, LDL lowered within 4-7 days, serum cholesterol low- ered within 1 mo, duration 2-4 wk
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• Adult: PO 4 g/day or bid, max 24 g/day
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